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As Roe’s end looms, a Memphis abortion clinic guides patients through uncertainty

Workers at Choices warn patients that they might not be able to keep their appointments, depending on when the Supreme Court decision lands.
Choices clinic
Choices, an abortion clinic in Memphis, also offers prenatal visits and gender-affirming care.Andrea Morales for NBC News

MEMPHIS, Tenn. — A sign on the wall at Choices, an independent abortion clinic in Memphis, bears a single word in fluorescent orange: “Onward.” 

That remains the focus of the clinic’s workers as they treat patients in what are likely the last days of abortion being a constitutionally protected right in this country.  

On a recent Tuesday, the phlebotomist — who is in her 70s and has a penchant for telling patients that they are in good hands — showed up dutifully for her shift inside the lime and pale green building. 

An administrator breezed through a crowded lobby, stopping to greet a couple and their small child waiting to be seen at the birthing center, one of the many health services the clinic offers beyond abortion care. 

A few yards away, staff members scheduling appointments kept their voices steady as they explained that if Roe v. Wade was overturned, the callers on the other end might not be able to have their procedures, depending on how far they were in pregnancy and the date the decision lands. 

A calendar that shows the final week of scheduled abortion procedures
Leaders at Choices decided to continue scheduling appointments while waiting for a Supreme Court ruling on abortion. Callers are cautioned that the decision may halt their ability to receive care.Andrea Morales for NBC News

Meanwhile, the chief executive officer and the development director were preparing to fly out to Colorado to raise funds for the new clinic in Carbondale, Illinois, a state where abortion is expected to remain legal. And they were strategizing on how they could continue offering a full spectrum of health services at the Memphis clinic — including midwifery and prenatal care in addition to gender-affirming care and wellness exams — a range that is rare among abortion clinics.

So much of what preceded the leak of a draft opinion signaling that the Supreme Court was on the precipice of overturning Roe v. Wade has been loud: The screams of protesters outside clinics. The cries of activists vowing that the country would not be dragged back into an era when women died from unsafe illegal abortions or from desperately performing the procedure on themselves. 

But at Choices, preparing for Roe’s end has been quieter. The executive team juggles the routine work of keeping the nonprofit clinic running, while calling board members to confirm strategy and relaying important updates to staff. 

“We need to continue to move through our world — and when it happens, it happens. And we will pivot and stop, right?” said Jennifer Pepper, the CEO of Choices. “They will get all that time and energy from us when the thing happens, and I can’t give them any more time and energy around it until it happens.”

Jennifer Pepper
Jennifer Pepper, the CEO at Choices, has continued to keep the clinic running while preparing for the Supreme Court's decision.Andrea Morales for NBC News

The “it” is what those who support or oppose abortion rights have anticipated since the day last year when the Supreme Court announced justices would review Mississippi’s previability abortion ban — a decision that could allow states to impose even greater restrictions on when patients can obtain the procedure, or ban it entirely.

If that happens, Tennessee is among 13 states where abortion care will become widely illegal. While some states’ “trigger bans” could take effect within hours of a Supreme Court decision, under Tennessee’s law, Choices would be able to continue to see patients for at least 30 days. 

But the services the clinic offers for those 30 days may be limited. Pepper expects that a separate Tennessee law banning most abortions after an ultrasound detects cardiac activity, or at around six weeks, would likely take effect within days if Roe falls. Almost 4,000 patients received abortion care from Choices last year, and only about 10%  of the procedures were done earlier than six weeks of pregnancy. 

For patients, the ruling was always going to land at a volatile time.

Many of those who arrive at Choices have jobs that pay hourly. They have to figure out child care. They have to figure out how to get to their first appointment and then turn around and do it again two days later because Tennessee requires women to wait 48 hours after their initial consultation to have an abortion. 

The clinic’s staff members worry about the many corners pregnant people would be pushed into all at once, in a city where the infant mortality rate in some ZIP codes is more than twice the national average and where roughly 1 in 4 residents live below the poverty line. What about those who don’t have a car that can make it for three hours on the road to reach the nearest safe location for an abortion? 

Maria Hassol, the operations director, worries about patients being blindsided by the court ruling.

“Many times, patients don’t know this is happening — it could create an issue,” she said. At a meeting with the clinic’s attorneys, she urged, “We have to tell them.”

Pepper said later in an interview that the clinic’s mission is in its name. 

“We’re Choices,” she said. “We can’t not provide information.”

So, the clinic’s leaders made what Pepper described as a “gut-wrenching” call in anticipation of the Supreme Court decision to only book appointments for callers who had not reached their sixth week of pregnancy by June 27.

On the morning of June 13, Lily Picard, an abortion doula who also works at the call center, spent more time providing the number of a clinic in Illinois than booking appointments at Choices. 

A whiteboard on the wall outlined administrative tasks and offered a reminder: “Answering phones is an art, a science, a ministry.”

When guiding patients through the abortion process as a doula, Picard thinks carefully about how, or whether, to place a hand on a patient. You never know if someone has had a traumatic experience of being restrained or held down, Picard said. An effort to provide comfort could be a trigger. That was part of adapting to what patients needed during their procedure. Sometimes that meant guiding them through meditation.   

Now it meant trying to support the callers who might not make it through the clinic’s doors. Allowing them to express their anger, their grief.

“It’s very heavy,” Picard said. 

By the next morning, the leadership team had made a new call. Pepper saw a prediction from a well-known constitutional law professor that the court’s decision, widely expected by late June, could come in July. The clinic would allow women to book appointments past the sixth week of pregnancy for now, but planned to begin waiving the $200 fee for the consultation visit. If the decision landed before their second appointment, that was money that the patients would need to travel to what Pepper calls “haven” states.

In the call center, the workers were now explaining to patients that there was uncertainty about whether they could receive care. Several accepted the risk and made appointments anyway.

“It’s a lot to manage,” Pepper said. “Folks like definitive information. Nobody likes, ‘We think this is what we know.’ There’s a lot to hold in that uncertainty. But I think if we continue to put the patients’ perspective first that they need service and let that lead our decision-making and not let fear or anxiety lead our decision-making, I think that’s what’s best for our community. And so that’s what we’re trying to do as best as we can every day.” 

A billboard for Life Choices
Across the street from the Choices clinic is a billboard for Life Choices, a pregnancy crisis center that does not offer abortions.Andrea Morales for NBC News

After that 30-day clock runs out, Choices will not shut its doors. The clinic has been working to crosstrain staff in the other health care services the clinic provides, including midwifery. In 2021, almost 90 pregnant people delivered their babies with the support of the center’s midwives. The clinic also launched a fellowship program to support Black midwives.

Keeping busy, Pepper said, has helped her deal with the grief. If all goes according to plan, the clinic in Carbondale will open on Aug. 1. Interviews for staff are slated to begin soon and a building has been purchased.  

“Everybody keeps saying it’s an aggressive timeline,” Pepper said.

“Well, the Supreme Court started it first y’all.”